DAS guidelines for the management of difficult airway; what should you know?

Summary

This video provides a comprehensive guide to managing unanticipated difficult airway scenarios in anesthesia. It details the steps anesthetists take, from pre-oxygenation and intubation techniques to dealing with challenges such as failed attempts. The script highlights various strategies, including the use of direct and video laryngoscopy, bougie, supraglottic airway devices, and fiber optic bronchoscopy. It also covers emergency procedures like cricothyroidotomy. Emphasizing perseverance and adaptability, the video showcases the critical role of anesthetists in overcoming airway difficulties and ensuring patient safety.

Takeaways

• 😀 Proper preparation is crucial for managing a difficult airway, including securing monitors, pre-oxygenation, and keeping suction equipment close to the patient's head.
• 😀 The first approach in an unanticipated difficult airway is direct laryngoscopy, with video laryngoscopy as a backup if necessary.
• 😀 If direct laryngoscopy is unsuccessful, using a bougie can assist in smoothly inserting the endotracheal tube into the trachea.
• 😀 In case of a failed first attempt, seeking assistance and ensuring proper oxygenation is vital before trying alternative approaches.
• 😀 If plan A fails, switching to a second-generation supraglottic airway device (LMA) is recommended for maintaining oxygenation.
• 😀 Confirmation of correct supraglottic airway placement should be done with capnography to ensure proper ventilation.
• 😀 If the supraglottic airway fails, using an Aintree catheter and fiber optic bronchoscope can assist with successful intubation through the device.
• 😀 Always bring the difficult airway management trolley to the operating room, as it contains specialized tools for handling challenging intubations.
• 😀 If plan B fails, consider face mask ventilation (Plan C) and follow a two-person technique to assist with ventilation.
• 😀 In extreme cases where face mask ventilation and intubation fail, proceed with Plan D: emergency front-of-neck access via cricothyroidotomy.
• 😀 Successful airway management requires adaptability, teamwork, and perseverance in difficult situations, ensuring that anesthetists and technologists work closely together.

Q & A

What are the first steps to prepare for an unanticipated difficult airway scenario?

The first steps include securing the monitors and checking vital signs, pre-oxygenating the patient, keeping a suction unit close to the patient's head, adjusting the table height for comfortable intubation, and inducing the patient once they are asleep.

What is the recommended initial technique for managing airway difficulty?

The recommended initial technique is direct laryngoscopy using a standard laryngoscope. If this proves difficult, a video laryngoscope can be used as an alternative.

How does a bougie assist during intubation?

A bougie helps guide and smoothly insert the endotracheal tube into the correct position when direct visualization of the vocal cords is challenging.

What should be done if the first attempt at intubation fails?

If the first attempt fails, assistance should be sought immediately, cricoid pressure should be removed, and oxygenation should be maintained while waiting for help.

What equipment is necessary for Plan B in the event of a failed Plan A?

Plan B requires the use of a supraglottic airway device, with a second-generation device being recommended. The difficult airway management trolley should also be brought in for additional tools and devices.

What actions should be taken when a supraglottic airway device insertion fails?

If the insertion fails, the position or size of the device should be adjusted, and a retry should be attempted. If successful, confirm the device’s position with capnography.

What is the purpose of an entry intubation catheter in Plan B?

The entry intubation catheter serves as a pathway for the subsequent insertion of the endotracheal tube when using a supraglottic airway device.

What is the next step if both Plan A and Plan B fail?

If both Plan A and Plan B fail, Plan C is initiated, which involves face mask ventilation. If this is also unsuccessful, the patient should be paralyzed, airway adjuncts should be used, and the two-person ventilation technique should be employed.

What does Plan D involve in the event that face mask ventilation fails?

Plan D involves performing an emergency front-of-neck access, specifically a cricothyroidotomy, to secure the airway when all other options have failed.

What key steps are involved in performing a cricothyroidotomy?

Key steps include identifying the larynx using a laryngeal handshake, making a transverse incision through the skin and cricothyroid membrane, inserting the bougie, and advancing the tracheal tube into the trachea. Proper ventilation is then confirmed with capnography.